Abstract
Tachycardiomyopathy (TCM) is an underestimated cause of reversible left ventricle dysfunction. The aim of this study was to identify the predictors of recurrence and incidence of major cardiovascular events in TCM patients without underlying structural heart disease (pure TCM). The prospective, observational study enrolled all consecutive pure TCM patients. The diagnosis was suspected in patients admitted for heart failure (HF) with a reduced ejection fraction and concomitant persistent arrhythmia. Pure TCM was confirmed after the clinical and echocardiographic recovery during follow-up. From 107 pure TCM patients (9% of all HF admission, the median follow-up 22.6 months), 17 recurred, 51 were hospitalized for cardiovascular reasons, two suffered from thromboembolic events and one died. The diagnosis of obstructive sleep apnoea syndrome (OSAS, hazard ratio (HR) 5.44), brain natriuretic peptide on admission (HR 1.01 for each pg/mL) and the heart rate at discharge (HR 1.05 for each bpm) were all independent predictors of TCM recurrence. The left ventricular ejection fraction at discharge (HR 0.96 for each%) and the heart rate at discharge (HR 1.02 for each bpm) resulted as independent predictors of cardiovascular-related hospitalization. Pure TCM is more common than previously thought and associated with a good long-term survival but recurrences and hospitalizations are frequent. Reversing OSAS and controlling the heart rate could prevent TCM-related complications.
Highlights
Tachycardiomyopathy (TCM) is an important cause of dysfunction of the left ventricle [1]
They hypothesized that patients with long-lasting atrial fibrillation could develop heart failure without any other evidence of structural heart disease, and such heart failure could completely disappear after the restoration of the sinus rhythm [4]
TCM is nowadays classified as a non-familial cause of dilated cardiomyopathy, doubts have been cast on the inclusion of such a disease among those conditions directly affecting the structure and/or function of the heart [5]
Summary
Tachycardiomyopathy (TCM) is an important cause of dysfunction of the left ventricle [1] It is defined as an arrhythmia induced cardiomyopathy in which the impairment of the left ventricle is secondary to rapid and/or asynchronous, irregular myocardial contraction and is partially or completely reversible after treatment of the triggering arrhythmia [2]. Both atrial and ventricular arrhythmias, as well as the premature atrial or ventricular complexes have been noted to cause TCM [1] and no specific heart rate cut-off at which the condition develops has been identified [3]. TCM is nowadays classified as a non-familial cause of dilated cardiomyopathy, doubts have been cast on the inclusion of such a disease among those conditions directly affecting the structure and/or function of the heart [5]
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